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A  REVIEW  OF  THE  HISTORY 
OF  CHEMICAL  THERAPY  IN 
CANCER. 

BY 

WILLIAM  S.  STONE,  M.D. 

NEW  TORK. 


REPRINTEI>  FEOM 
THE 

MEDICAL  RECORD 

October  7,  1916. 


WILLIAM  WOOD  &  COMPANY 

NEW    YORK. 


A  REVIEW  OF  THE  HISTORY  OF  CHEMICAL 
THERAPY   IN    CANCER. 

By  WILLIAM  S.   STONE,  M.D., 
NBW   YORK. 

The  presentation  of  a  method  of  cancer  therapy 
other  than  operation  with  the  knife  has  usually 
been  conceived  either  in  ignorance  or  in  the  hope 
of  financial  gain.  In  the  case  of  the  chemical 
caustics,  unfortunately  for  progress  in  the  treat- 
ment of  the  disease,  the  unqualified  condemnation 
of  the  manner  of  their  exploitation  has  repeatedly 
prevented  educated  surgeons  from  learning  how  to 
use  them  and  excluded  a  scientific  study  of  their 
possible  efficiency. 

It  is  a  remarkable  fact  that,  so  far  as  "cancer 
cures"  relate  to  the  local  treatment  of  the  disease, 
they  have  almost  invariably  been  found  to  consist 
of  arsenic,  zinc,  or  the  alkaline  caustics.  Arsenic 
is  known  to  have  been  the  effective  ingredient  of 
the  applications  made  to  cancerous  tumors  by  the 
Indians,  Egyptians,  and  Persians,  and  a  salve, 
designated  as  Unguentum  Egypticum,  consisting 
of  arsenic  and  vinegar,  was  in  general  use  until 
the  middle  of  the  fourteenth  century,  when  two 
notable  surgeons  of  the  University  of  Avignon, 
Henri  de  Mondeville  and  Guy  de  Chauliac,  made  ef- 

Copyright,  William  Wood  &  Company. 
1 


forts  to  improve  the  methods  of  diagnosis  and 
treatment.  Prior  to  this  period  it  is  clear  that  all 
classes  of  people — physicians,  scholars,  mendicant 
friars,  and  old  women — treated  all  kinds  of  tumors 
with  escharotic  pastes  and  solutions,  the  most  ef- 
fective of  which  contained  arsenic.  The  most  skill- 
ful applications  were  undoubtedly  made  by  the 
friars.  The  Hippocratic  theory  of  the  nature  of 
cancer,  "the  atra  bills,"  was  recognized  in  all  thera- 
peutic efforts,  but  exerted  little  influence  on  the 
methods  of  treatment.  Diagnostic  error,  as  a  factor 
in  the  determination  of  successful  results,  applied 
alike  to  the  use  of  the  knife  and  to  caustics.  While 
Galen  and  others  of  the  Greek  school  supported  this 
theory,  two  kinds  of  growth  were  differentiated: 

(1)  the  so-called  scirrhus,  which  evidently  included 
both  benign  tumors  and  the  hard,  slowly  growing, 
and  more  definitely  localized  malignant  growths; 

(2)  those  growths  which  were  plainly  evident  to 
both  patients  and  physicians  as  the  more  rapidly 
growing  and  destructive  neoplasms.  It  is  probable 
that  chemical  caustics  were  more  generally  used 
than  either  the  knife  or  the  heated  iron,  especially 
with  the  ulcerating  grov^ths. 

Guy  de  Chauliac  (1368),  a  great  writer  on 
surgery,  as  well  as  a  skillful  operator,  directed  at- 
tention to  the  use  of  caustics  as  an  adjuvant  to  the 
use  of  the  knife.  He  used  arsenic  mixed  with  clay 
and  noted  no  toxic  symptoms  from  its  employment. 
Ambroise  Pare  (1510-1590),  by  his  development  of 
the  use  of  ligatures  and  sutures,  created  a  fresh 
enthusiasm  for  the  use  of  the  knife  in  the  treatment 
of  cancer,  and,  although  using  mild  salves  and  solu- 
tions on  ulcerating  growths,  tried  to  discredit  the 
use  of  arsenic  because  of  the  baleful  effects  of  its 
indiscriminate  application.    In  Germany,  Fabricius 

2 


Hildanus  (1560-1634),  who  was  known  as  a  skillful 
operator,  and  is  reported  to  have  excised  the  axil- 
lary glands  in  amputation  of  the  breast,  also  tried 
to  discredit  the  use  of  arsenic.  We  find,  however, 
little  evidence  during  the  succeeding  centuries  that 
surgery  profited  much  by  the  possibilities  which 
the  work  of  Pare  and  Fabricius  had  indicated. 
Clowes,  physician  to  Queen  Elizabeth,  advocated  as 
an  additional  therapeutic  procedure  the  laying  on 
of  the  Queen's  hand.  In  Germany,  theories  regard- 
ing the  nature  of  cancer  simply  became  more  nu- 
merous, and  under  the  designation  of  "systems" 
their  chief  practical  achievement  was  the  exploita- 
tion of  a  constitutional  cure  in  the  form  of  conium 
maculatum  by  a  Dr.  Storck  of  Vienna,  in  1761,  an 
account  of  which  eleven  years  later  extolled  its 
merits  and  the  discoverer  in  terms  of  the  highest 
praise.  In  1779  a  society  in  Bantzen  offered  a  prize 
of  30  ducats  for  a  cure  of  cancer  without  the  use  of 
the  knife,  mercury,  cicuta,  stramonium,  belladonna, 
napello,  and  aconite,  but  there  is  no  record  of  any 
award  of  the  prize.  In  France  the  efforts  to  apply 
the  recent  discoveries  in  chemistry  to  the  study  of 
the  nature  of  cancer  had  elicited  the  fact  that 
tumors  arise  from  the  same  tissue  in  which  they 
appear.  In  1773  Bernard  Peyrilhe,  in  a  thesis 
offered  for  the  prize  question  by  the  Academy  of 
Lyons,  "Qu*est-ce  le  cancer,"  presented  a  scientific 
interpretation  of  the  subject,  and  is  credited  with 
being  the  first  to  make  use  of  animal  experimenta- 
tion in  the  study  of  the  disease.  The  dog,  however, 
into  whose  back  the  cancerous  material  had  been 
injected,  howled  so  continuously  from  the  resulting 
lesion  that  its  keeper  removed  him  from  the  field 
of  Peyrilhe's  observations.  In  regard  to  treatment, 
he  recommended  for  cancer  of  the  breast  the  re- 

3 


moval  of  the  breast,  excision  of  the  axillary  glands, 
and  the  removal  of  the  pectoralis  major  muscle. 
For  the  treatment  of  nasal  cancer  he  advocated  the 
use  of  the  recently  discovered  "kohlsaure." 

The  beginning  of  the  nineteenth  century  was 
marked  by  efforts  to  overthrow  ancient  philosophy 
and  medieval  empiricism,  and  a  new  era  in  the  con- 
ception and  treatment  of  cancer  appeared  through 
the  English  and  French  anatomical  researches. 
While  John  Hunter's  (1786)  lymphatic  theory  domi- 
nated the  minds  of  the  majority  of  the  great  sur- 
geons, it  included  a  new  conception  of  cancerous 
growths  as  being  the  result  of  some  vital  activity 
on  the  part  of  normal  tissues  and  subject  to  the 
same  laws  of  life,  growth  and  nourishment  as  the 
normal  organism.  In  London  (1771)  the  Middle- 
sex Hospital  had  established  a  special  ward  for 
cancer  patients,  and  in  1802  a  committee  of  London 
surgeons  was  formed  for  the  investigation  of  the 
nature  and  cure  of  cancer.  During  the  three  years 
of  its  existence  its  chief  attainment  was  the  dis- 
tribution to  the  medical  profession  in  England  of 
an  elaborate  questionnaire,  the  result  of  which  was 
as  futile  as  it  probably  would  be  to-day  if  a  similar 
method  was  pursued.  Among  the  practical  sur- 
geons there  were  two  factions  regarding  the  theory 
of  cancer — the  "localists"  and  the  "constitutional- 
ists." The  latter  did  not  hold  to  a  specific  theory, 
but  their  ranks  were  largely  derived  from  the  ortho- 
dox surgeons  of  the  day  who  had  been  so  uniformly 
disappointed  with  the  results  of  their  operative 
work. 

A  publication  by  Young  in  London  appeared  in 
1805  on  cancer  and  the  use  of  chemical  caustics  in 
its  treatment,  in  which  a  remarkably  clear  summary 
is  given  of  the  fallacious  arguments  of  those  who 


maintained  that  cancer  has  a  specific  virus,  is  con- 
tagious or  hereditary,  and  its  action  constitutional. 
His  own  conception  of  cancer  presents  with  aston- 
ishing accuracy  the  present  views  of  scientific  men. 
"Morbid  and  natural  structures,  having  the  same 
principle  necessary  to  each  and  governing  both," 
he  says,  "a  morbid  alteration  should  never  be 
viewed  independently  of  the  natural  organization 
and  functions  of  the  part,  or  as  beyond  the  laws  of 
life."  Briefly  summarized,  he  considers  cancer  as  a 
growth  arising  from  acquired  actions  about  a  local 
structure  that  has  been  altered  by  injury  or  disease. 
On  the  recurrence  of  cancer,  he  says:  "It  must  be 
obvious  that  the  disease  arises  from  such  small  be- 
ginnings, unfortunately,  that  it  can  never  be  de- 
tected until  the  obstruction  has  made  considerable 
progress ;  and,  as  no  specific  virus  is  with  it  so  as  to 
offer  any  peculiar  evidence  from  which  one  might 
take  alarm,  the  disease  thus  proceeds  securely  in 
the  minute  parts  of  structure  until  such  a  circle  of 
alteration  is  acquired  as  to  make  the  change  evident 
to  the  touch ;  so  that  when  a  surgeon  takes  out  such 
a  scirrhus  tumor  it  is  impossible  to  act  beyond 
the  reach  of  his  perceptions,  and  to  discover 
changes  which  can  only  be  imagined,  which  may  be 
there,  or  may  not.  .  .  .  It  is  impossible  to  as- 
certain the  distinct  line  between  health  and  disease, 
and  .  .  .  some  portions  may  be  left,  from 
which  .  .  .  the  disease  may  ultimately  recur." 
Based  upon  this  conception  of  the  disease.  Young 
directed  the  attention  of  the  educated  physician  to 
the  advantages  which  he  believed  the  chemical 
caustics  possessed  if  they  were  more  discriminately 
and  skillfully  applied.  He  says:  "It  must  be  very 
evident  to  the  most  sanguine  expectations  that  this 
disease,  although  the  treatment  of  it  in  the  future 


may  be  greatly  improved,  must  still,  in  many  in- 
stances, fall  short  of  all  possitility  of  cure.  But 
.  .  .  are  we  to  relax  in  effort  because  effort  is 
more  required?  Shall  we  withhold  what  can  be 
done,  merely  because  all  that  we  wish  cannot  be 
done?  Such,  however,  seems  to  have  been  the  des- 
perate sentiment  in  which  science  has  left  the  dis- 
ease almost  to  itself.  It  appears  to  have  been  con- 
sidered as  a  thing  so  deeply  rooted  in  its  own  sin 
and  wickedness  as  to  be  beyond  reprieve — a  hard- 
ened malefactor,  denied  every  consolation  but  that 
of  the  knife.  This  negligence  on  the  part  of  sci- 
ence has  given  proportionate  scope  to  the  invention 
of  the  quacks:  they  have  seized  upon  the  arms  the 
regulars  threw  away,  and  have  certainly  played  no 
unsuccessful  part.  Even  old  women,  enlisted  under 
the  banners  that  were  deserted,  have  proved  at  least 
(as  far  as  their  knowledge  of  the  question  went) 
that  there  is  just  as  much  orthodoxy  in  a  piece  of 
caustic  as  in  a  piece  of  iron." 

As  illustrating  the  attitude  of  the  regular  sur- 
geon at  that  time  toward  the  use  of  caustics.  Young 
narrated  the  story  of  a  published  correspondence 
between  two  surgeons  of  the  time.  A  regular  sur- 
geon, Mr.  Guy,  had  purchased  a  nostrum,  known  as 
the  'Tlunket  remedy,"  which  he  had  been  using 
extensively  and  apparently  successfully  without  dis- 
closing its  composition,  but  claiming  it  had  none  of 
the  qualities  of  a  caustic.  The  surgeon  to  the  King, 
Mr.  Gataker,  who,  it  afterward  was  ascertained, 
had  also  been  using  a  caustic  without  the  same  suc- 
cess as  had  his  colleague,  publicly  and  vehemently 
denounced  Mr.  Guy  because  he  was  using  a  secret 
remedy.  The  efficient  ingredient  of  the  "Plunket 
remedy"  was  eventually  ascertained  to  be  arsenic. 
Young  says:  "Thus  posterity  seems  equally  obliged 


to  these  two  gentlemen;  to  the  one  for  condemning 
a  thing  which  it  is  very  evident  he  was  totally 
ignorant;  and  to  the  other  for  the  warm  support 
of  what  it  is  equally  clear  he  did  not  understand, 
or  (which  would  seem  still  less  innocent)  of  what 
he  did  not  choose  to  understand."  Young  indicates 
that  a  more  general  use  of  caustics  became  intro- 
duced from  this  remedy,  w^hich  considering  the  un- 
qualified and  indiscriminating  way  in  which  they 
were  applied,  were  attended  with  more  success,  he 
says,  than  could  have  been  looked  for. 

Young  conceived  that  the  advantage  gained  by 
the  proper  use  of  caustics  was  derived  from  their 
power  of  exciting  newly  formed  tissues  into  an  ac- 
tivity beyond  their  power,  which  is  always  less  than 
normal  structures.  For  this  purpose  he  considered 
arsenic  as  particularly  well  suited  because  its  action 
extended  to  all  of  the  tumor  tissue  without  rapidly 
producing  a  superficial  eschar,  the  formation  of 
which  prevents  the  extension  of  the  action  to  the 
deeper  parts.  An  old  preparation,  known  as  Magnes 
Arsenicales,  which  he  regarded  as  most  efficacious, 
consisted  of  equal  parts  of  antimony,  sulphur,  and 
arsenic,  the  antimony,  he  believed,  adding  to  the 
extent  of  the  area  affected.  Young  urged  the  im- 
portance of  applying  treatment  during  the  early 
stages  of  the  disease,  and,  in  order  to  avoid  con- 
cealment of  these  tumors  until  it  is  too  late,  he 
writes  as  follow^:  "So  long  as  the  extirpation  of 
scirrhi  of  the  breast  is  performed  by  the  knife,  so 
long  shall  we  have  the  disease  fostered  in  secret, 
and,  in  too  many  instances,  procrastinated  beyond 
the  point  of  safety,  through  the  dread  of  an  opera- 
tion that  is  inevitably  dreadful.  For  the  operator 
may  argue  until  doomsday  ere  he  shall  persuade  his 
patient  that  cutting  the  breast  with  the  knife  is  a 


mere  nothing.  .  .  .  This  rhetoric  never  gained  a 
jot  on  the  fears  of  ignorance,  or  on  the  quick  feel- 
ings of  diseased  deUcacy.  The  truth  is  that,  when 
the  operation  is  submitted  to,  the  mind  is  seldom 
made  up  to  it  but  as  a  last  resort — seldomer  from 
the  convictions  of  reason,  and  never  from  an  abso- 
lute command  over  the  natural  terrors  of  the 
heart." 

There  is  no  reason  to  doubt  that  Young's  pres- 
entation of  the  subject  had  a  favorable  effect  on 
the  professional  mind  in  both  England  and  France. 
He  was  a  graduate  of  the  Middlesex  Hospital,  and, 
although  not  a  member  of  the  staff  of  that  institu- 
tion, he  was  a  protege  of  Mr.  Brodbeck,  who  made 
the  first  financial  contribution  to  the  establishment 
of  its  cancer  ward.  He  became  better  known  by  a 
publication  in  1815  on  the  treatment  of  cancer  by 
compression,  a  method  which  received  wide  atten- 
tion for  many  years.  Recamier  was  enthusiastic 
about  its  efficacy,  and  devoted  two  volumes  to  a  dis- 
cussion of  its  principles  and  technical  application. 

From  the  beginning  of  the  nineteenth  century  we 
find  that  all  of  the  noted  surgeons  felt  the  need  of 
some  adjuvant  to  or  substitute  for  the  use  of  the 
knife,  and  until  the  last  quarter  of  the  century  the 
use  of  caustics  in  cancer  therapy  was  regularly  dis- 
cussed in  the  standard  surgical  textbooks.  There 
are,  however,  few  contributions  to  their  technical 
application  and  very  little  discussion  of  the  kind 
of  cases  to  which  they  are  applicable.  Of  all  the 
noted  surgeons  of  his  time  Velpeau  seems  to  have 
made  the  most  use  of  them,  a  paste  designated  as 
"caustique  noir,"  consisting  of  concentrated  sul- 
phuric acid  made  into  a  paste,  being  his  favorite 
formula.  He  says:  *T  have  frequently  employed 
caustiQs  in  the  treatment  of  cancer,  and  I  have  fre- 

8 


quently  thought,  I  must  confess,  that  they  have 
more  certainly  prevented  secondary  cancerous  af- 
fections in  the  neighboring  glands  than  the  ex- 
tirpation with  the  knife.  I  have  twice  seen  volu- 
minous and  indurated  glands  in  the  axilla  diminish 
in  a  remarkable  degree  during  the  period  I  was  de- 
stroying a  cancer  of  the  breast  by  caustics,  and  I 
have  observed  the  same  effect  on  the  submaxillary 
glands,  while  cancer  ...  of  the  lower  lip  was 
treated  in  a  similar  manner."  Maisoneuve  also  re- 
fers repeatedly  to  the  efficiency  of  caustics,  espe- 
cially of  the  chloride  of  zinc,  in  the  removal  of  can- 
cerous tumors,  and  of  the  long  interval  before  they 
recurred.  Dupuytren,  as  a  part  of  his  armamenta- 
rium, used  a  paste  consisting  of  two  parts  of  arse- 
nic and  200  parts  of  calomel,  which  Parker  refers 
to  as  generally  too  feeble  in  its  action.  Manec,  of 
the  Salpetriere  Hospital,  Paris,  used  a  paste  con- 
sisting of  one  part  arsenous  acid,  eight  parts  of 
cinnibar,  and  four  parts  of  burnt  sponge,  made  into 
a  paste  with  a  few  drops  of  water.  The  results 
from  its  use  were  favorably  commented  upon  by 
Lebert,  who,  Parker  says,  was  not  an  ardent  advo- 
cate of  caustics.  All  of  these  cases  had  been  re- 
ferred to  Manec  by  other  distinguished  surgeons  as 
incurable. 

Sir  Astley  Cooper  is  quoted  by  Parker  as  follows : 
"It  behooves  medical  men  to  direct  their  minds  to 
the  trial  of  the  numerous  agents  which  chemistry 
and  botany  have  lately  abundantly  discovered  and 
simplified."  Most  of  the  pastes  used  during  the 
first  third  of  the  nineteenth  century  consisted  either 
of  arsenic  or  the  mineral  acids,  chiefly  the  former, 
and  numerous  accidents  resulted  from  their  use. 
Parker  observed  arsenic  in  the  urine  twelve  hours 
after  the  first  application,  which  continued  to  be 


detected  during  a  period  of  eight  or  ten  days.  Toxic 
symptoms  are  recorded  as  occurring  after  the  use  of 
such  strong  pastes  as  the  very  old  one,  known  as 
Frere  Gome's,  which  is  said  to  have  cured  Pope 
Gregory  X  of  a  cancer  of  the  face.  Maisoneuve 
mentions  several  cases  in  which  its  employment 
produced  vomiting,  precordial  anxiety  and  other 
symptoms. 

During  the  years  1834-1838  Ganquoin  of  Paris 
reported  the  results  which  he  had  obtained  from  the 
use  of  a  paste,  the  essential  ingredient  of  which  was 
chloride  of  zinc.  He  described  four  formulae,  as 
follows:  (1)  equal  parts  of  zinc  and  flour;  (2)  zinc 
one  part,  flour  two  parts;  (3)  zinc  one  part,  flour 
three  parts ;  (4)  zinc  one  part,  muriate  of  antimony 
one  part,  flour  11/2  parts.  Water  from  20  to  30 
drops  for  each  formula.  In  1838  a  complete  ac- 
count of  his  results  in  600  cases  was  published,  in 
which  the  recurrences  were  given  as  12  per  cent. 
as  compared  with  75  per  cent,  after  the  use  of  the 
knife.  Regarding  the  details  of  its  application  he 
says  that  formula  (1)  applied  four  lines  in  thick- 
ness for  48  hours  destroys  the  parts  to  a  depth  of 
11/2  inches;  that  the  same  formula  three  lines  in 
thickness  applied  for  the  same  length  of  time  acts 
only  to  about  the  depth  of  an  inch.  The  depth  to 
which  the  paste  acts  can,  he  says,  with  a  little  prac- 
tice be  regulated  to  the  utmost  nicety,  depending 
upon  its  strength  and  the  time  it  is  applied.  Plas- 
ter of  paris  may  be  substituted  for  flour,  thus  ren- 
dering it  less  delinquescent.  The  antimony  was 
added  in  formula  (4)  to  give  it  the  same  consistence 
as  soft  wax  that  it  may  be  applied  more  uniformly 
over  an  unequal  surface,  such  as  is  presented  by  an 
ulcerating  growth.  The  advantage  of  the  Ganquoin 
paste  over  the  arsenical  preparations  is  attested  by 

10 


the  fact  that,  with  few  exceptions,  chloride  of  zinc 
has  been  the  effective  ingredient  of  all  pastes  since 
used  by  surgeons  and  quacks.  Parker  (1867)  says: 
"The  chloride  of  zinc  will  effectually  remove  the 
chief  evil  attendant  on  the  application  of  caustic 
remedies  to  the  destruction  of  cancerous  growths — 
the  amount  of  prolonged  pain  they  occasion.  It 
may  be  applied  with  a  degree  of  precision  unob- 
tainable by  any  other  caustic ;  it  destroys  the  tissue 
in  direct  relation  with  the  thickness  of  the  layer 
applied;  it  never  runs  or  fuses;  it  destroys  only 
those  parts  which  it  covers,  and  these  it  divides 
from  the  surrounding  structures  as  cleanly  as 
though  they  had  been  cut  with  a  knife.  The  crust 
or  scab  formed  by  this  caustic  is  hard,  dense,  and 
white;  there  is  no  sanguinous  or  other  discharge 
produced  by  it.  The  eschar  separates  at  the  end  of 
twelve  or  fourteen  days,  leaving  a  clean,  healthy 
granulating  surface  underneath."  In  1855  there  ap- 
peared in  the  Dublin  Quarterly  Journal  a  method 
introduced  by  Llandolfi,  chief  surgeon  of  the  Sicil- 
ian army  and  Clinical  Professor  of  Cancerous  Dis- 
eases in  the  Trinity  at  Naples,  in  which  he  used 
bromine,  either  alone  or  in  combination  with  the 
chlorides  of  zinc,  antimony  and  gold.  TTie  introduc- 
tion of  this  method  was  not  enveloped  in  any  mys- 
tery, and  Llandolfi's  personality  and  method  of 
presentation  produced  such  a  favorable  impression 
in  Paris,  Germany  and  Vienna  through  which  he 
traveled  that  his  paste  was  tried  by  many  and 
used  with  considerable  success. 

The  efficiency  of  chloride  of  zinc  is  illustrated  by 
the  story  Parker  relates  of  a  Dr.  Fell,  an  American, 
who  went  to  London  and  so  successfully  treated  nu- 
merous cases  of  cancer  that  a  certain  number  of 
patients  at  the  Middlesex  Hospital  were  placed  at 

11 


his  disposal  under  the  condition  that  he  reveal  and 
publish  the  composition  of  his  remedy.  This  was 
ascertained  to  consist  of  equal  parts  of  chloride  of 
zinc  and  a  decoction  of  sanguinaria  canadensis,  with 
enough  flour  to  make  a  suitable  paste.  The  hos- 
pital staff  were  apparently  favorably  impressed  with 
the  results.  A  little  later,  a  Dr.  Pattison,  a  London 
homeopathic  physician,  in  association  with  an 
American  from  Louisiana,  vaunted  a  remedy  as  a 
sure  cure  for  cancer  without  the  use  of  the  knife 
or  caustics,  the  results  of  which  had  evidently  ob- 
tained for  the  exploiters  considerable  fame  and  for- 
tune. Their  refusal  to  reveal  the  nature  of  their 
remedy  prevented  its  being  tried  at  the  Middlesex 
Hospital,  but  it  was  subsequently  found  to  be  a 
combination  of  chloride  of  zinc  and  hydrastis  cana- 
densis. Both  Fell  and  Pattison  administered  the 
"novelty"  in  their  preparations  also  internally,  the 
latter  in  a  dilution  commensurate  with  his 
homeopathic  traditions. 

It  is  clear  that  the  staff  of  the  Middlesex  Hos- 
pital, as  well  as  surgeons  of  other  hospitals,  must 
have  had  innumerable  experiences  of  this  kind,  but 
the  results  were  evidently  sufficient  to  make  the  use 
of  caustics — in  the  earlier  years  of  arsenic,  and 
later,  after  the  work  of  Canquoin,  of  the  chloride 
of  zinc,  an  important  adjuvant  to  the  use  of  the 
knife.  Moore  and  De  Morgan,  of  the  Middlesex  Hos- 
pital, the  former  of  whom  is  known  especially  for 
his  work  in  the  development  of  the  radical  operation 
with  the  knife,  used  weak  solutions  of  chloride  of 
zinc — 20,  30,  40  grains  to  the  ounce  of  water,  after 
their  cutting  operations  in  order  to  destroy  cancer 
cells  that  may  have  been  disseminated  through  the 
wound  or  the  neighboring  tissues.  De  Morgan 
was  so  well  satisfied  with  the  improved  results  from 

12 


this  method  that  he  expresses  the  hope  that  it  will 
be  more  extensively  applied.  They  found  that  the 
use  of  these  solutions  made  no  appreciable  differ- 
ence with  the  primary  healing  of  their  wounds. 

A  disadvantage  in  the  use  of  the  chloride  of  zinc 
was  its  failure  to  satisfactorily  remove  the  normal 
skin  over  the  tumor  site,  and  for  this  reason  in  part 
the  alkaline  caustics  and  mineral  acids  retained 
their  vogue.  The  well-kno'\;vTi  Vienna  paste  consisted 
of  five  parts  of  potassium  hydrate  and  six  of  quick 
lime.  The  "Filhos"  caustic  contained  the  same 
ingredients  in  different  proportions,  and  was  fused 
and  run  into  leaden  tubes  like  nitrate  of  silver  or 
potassa  fusa.  Of  the  mineral  acids,  nitric  acid  was 
introduced  by  Rivallie  (1850),  in  the  form  of  mono- 
hydrated  nitric  acid  made  into  a  paste  with  scraped 
linen  or  charpie.  For  cancer  of  the  servix  uteri, 
Routh  (1866)  advocated  to  the  Obstetrical  Society 
of  London  the  use  of  bromine — five  grains  to  the 
ounce  of  spirits  of  wine.  Tilt  indicates  that  in  his 
hands  and  others  the  application  of  the  acid  nitrate 
of  mercury  to  a  cancer  of  the  uterus  produced  satis- 
factory results. 

Reviewing  the  situation  from  the  text-book  litera- 
ture of  the  sixth  and  seventh  decades  of  the  nine- 
teenth century,  we  find  Thomas  (1869)  expressing 
the  opinion  that,  if  it  should  be  impracticable  to  re- 
move completely  a  cancer  of  the  cervnx  by  amputa- 
tion with  the  ecreseur,  scissors,  or  the  galvano- 
cautery,  it  should  be  destroyed  as  completely  as  pos- 
sible by  the  actual  cautery,  potassa  cum  calce,  or  one 
of  the  mineral  acids.  Erichson  says :  ''The  employ- 
ment of  caustics  .  .  .  requires  neither  knowl- 
edge of  anatomy  nor  of  operative  surgery,  and  so 
they  have  always  been  popular  with  many  who 
would  hesitate  to  use  the  knife.     In  this  country, 

13 


however,  .  .  .  they  have  not  perhaps  been 
legitimately  employed  to  the  extent  they  deserve. 
The  chief  argument  in  favor  of  caustics  is  that 
when  cancers  are  thus  destroyed  they  are  less  liable 
to  relapse  than  when  extirpated  with  the  knife. 
There  is,  however,  no  positive  proof  of  this  before 
the  profession;  but  it  is  not  improbable  that  the 
chemical  action  of  the  caustics  may  extend  so  widely 
into  neighboring  structures  as  to  destroy  or  render 
unproductive  the  cancer  cells  by  which  they  are  in- 
filtrated, and  on  the  development  of  which  the  local 
recurrence  of  the  disease  depends.  Another  advan- 
tage urged  in  favor  of  caustics  is  that  enlarged 
glands  are  more  likely  to  go  down  under  their  use 
than  when  the  primary  cancer  is  extirpated  by  the 
knife."  In  1872  Bougard,  a  prominent  Belgian 
surgeon,  wrote  most  enthusiastically  of  the  advan- 
tages in  the  use  of  caustics,  stating  that  recurrences 
were  less  frequent  than  after  the  use  of  the  knife. 
His  formula,  consisting  largely  of  chloride  of  zinc 
with  a  small  amount  of  arsenic,  was  used  by  nu- 
merous surgeons  for  several  years.  Willard  Parker 
(1873),  in  a  paper  on  cancer  of  the  female  breast, 
says:  "In  the  superficial  cancer  of  the  breast  it  is 
very  well  to  use  caustics.  The  same  thing  might  be 
said  with  regard  to  cancers  upon  the  face.  The 
treatment  with  caustics  in  that  region  is  good  sur- 
gery. When  the  tumor  is  situated  to  any  extent 
below  the  surface,  the  idea  of  caustics  is  bad  sur- 
gery." He  referred  to  two  cases  of  fatal  poisoning 
from  their  use.  In  the  discussion  of  this  paper 
Fordyce  Barker  says :  "Because  of  the  general  use  of 
caustics  by  charlatans  a  great  majority  of  the  surgi- 
cal world  have  been  satisfied  with  regard  to  their 
uselessness.  My  own  prejudices  have  always  been 
against  this  method  of  treatment."     As  a  result  of 

14 


his  observations  in  the  St.  Bartholomew's  Clinic  in 
London,  the  whole  process  seemed  so  revolting  that 
he  did  not  pursue  his  investigations  further  for 
some  time.  In  1870,  however,  he  became  so  pleased 
with  the  work  which  he  saw  in  the  London  Cancer 
Institute  by  Marsden  that  he  applied  this  method 
of  treatment  successfully  in  two  cases — one  a  can- 
cer of  the  breast  in  which  an  operation  with  the 
knife  had  been  refused,  the  other  a  cancer  of  the 
cervix  uteri.  He  used  the  Marsden  paste,  which 
consisted  of  equal  parts  of  arsenious  acid  and 
acacia.  Sands,  in  his  discussion  of  Parker's  paper, 
said  that  he  had  had  no  experience  with  the  use 
of  caustics,  but  used  the  knife  for  the  following 
reasons:  (1)  Nature  of  the  tumor  can  not  be  de- 
termined prior  to  its  removal;  (2)  now  and  then 
undoubtedly  a  malignant  tumor  is  cured  by  opera- 
tion; (3)  expediency.  J.  Collins  Warren  says:  "I 
have  had  little  experience  with  the  use  of  caustics. 
I  find  little  difficulty  in  persuading  patients  to  re- 
sort to  more  radical  measures."  About  the  face, 
to  rodent  ulcer,  he  preferred  the  use  of  the  cautery, 
especially  near  the  angle  of  the  eye,  because  there 
resulted  less  of  a  scar,  it  being  more  difficult,  he 
thought,  to  be  economical  of  tissues  with  the  knife, 
and  more  deformity  resulted  than  when  nature  is 
allowed  to  borrow  skin  from  all  directions. 

Stephen  Smith  (1880)  describes  his  use  of  the 
anhydrous  sulphate  of  zinc  in  the  form  of  a  powder, 
using  a  strong  sulphuric  acid  paste  for  the  removal 
of  the  skin.  He  says :  'This  remedy,  though  all  but 
discarded  by  surgeons  in  the  treatment  of  cancer, 
has  a  place  in  the  therapeutics  of  cancer  not  yet  ac- 
curately defined.  It  is  one  of  the  destructive  meas- 
ures which  we  may  resort  to,  having  capacities 
limited  only  by  the  possibilities  of  its  application. 

15 


As  ordinarily  employed,  its  real  virtues  are  not 
fairly^nor  adequately  defined.  We  are  advised,  or 
rather  permitted  by  authorities  to  apply  caustics  to 
ulcerated  cancerous  surfaces,  the  growth  no  longer 
being  amenable  to  the  knife.  That  is,  caustics  are 
recommended  as  a  last  resort,  when  the  disease  has 
taken  such  deep  root  that  it  is  certain  to  prove 
fatal.  If  useful  under  such  circumstances,  may  they 
not  be  far  more  serviceable  at  an  earlier  period? 
In  my  experience  caustics  judiciously  selected  and 
thoroughly  and  persistently  applied  give  the  best 
results  of  any  method  of  treatment  yet  adopted." 
Dabney  (1882)  also  reports  favorable  results  from 
the  use  of  this  powder.  Billroth  (1889)  expressed 
his  preference  for  the  use  of  the  knife,  but  in  very 
old,  anaemic,  or  timid  patients,  thought  caustics 
may  be  employed,  and,  if  the  treatment  be  continued 
until  all  the  diseased  portion  is  destroyed,  the  result 
will  be  favorable.  "Physiologically,"  he  says,  "caus- 
tics would  have  some  advantages;  for  it  is  sup- 
posable  that  the  cauterizing  fluid  may  enter  the 
finest  lymphatic  vessels,  and  thus  more  certainly 
destroy  the  local  disease.  But  this  does  not  occur 
readily,  because  the  tissue  with  which  the  caustic 
comes  in  contact  instantly  combines  with  it,  and  its 
further  flow  is  thus  prevented."  For  a  caustic  Bill- 
roth preferred  chloride  of  zinc.  Robinson  (1892),  in 
discussing  the  treatment  of  cutaneous  epitheliomas, 
says  that  caustics  with  less  scar  remove  more  tissue 
than  the  knife.  He  used  caustic  potash  and  the 
formula  of  Bougard.  Lewis  (18931)  used  the  Mars- 
den  paste  for  a  number  of  years  in  the  treatment 
of  superficial  cancer  of  the  skin.  Snow  (1893) 
writes  of  the  advantages  obtained  in  the  use  of  caus- 
tics on  small  superficial  lesions,  and  in  chronic 
epitheliomas,    or    rodent    ulcers.      He    considered 

16 


potassa  fusa  to  be  the  most  thorough  and  rapid,  its 
action  being  instantaneously  checked  by  the  use  of 
water,  and  causing  no  subsequent  pain  or  shock. 
Parmenter  (1894)  says  that  it  has  not  been  proved 
whether  caustics  are  better  or  worse  than  the  knife, 
but  he  believes  that  the  intelligent  application  of  a 
proper  caustic  to  easily  accessible  and  definitely 
localized  tumors,  such  as  those  of  the  skin,  lip  and 
external  ear,  has  many  advantages.  Bulkley  (1894) 
has  found  use  for  Marsden's  paste,  the  potassa  fusa, 
and  Bougard's  formula  in  early  superficial  malig- 
nant growths.  Allen  (1904)  takes  exception  to 
White's  statement  that  "the  caustic  treatment  in 
the  form  of  injections,  pastes,  and  all  other  kinds 
of  mixtures,  rarely  prove  of  any  service,  and  usually 
only  deceive  and  render  more  uncomfortable  the  ex- 
istence of  a  patient.  They  have  been  discarded  by 
almost  all  except  charlatans."  Impressive  evidence 
of  the  value  which  the  proper  application  of  caustics 
may  still  possess  in  cancer  therapy  is  furnished  by 
the  following  words  of  Halsted  (1907),  in  a  paper 
on  Carcinoma  of  the  Breast:  "I  am  indubitably 
convinced  that  the  local  and  regionary  recurrences 
after  incomplete  operations,  which  come  with  amaz- 
ing rapidity  when  the  knife  has  been  used,  are,  to 
say  the  least,  relatively  late  in  making  their  appear- 
ance when  chemical  or  actual  cauterization  has  been 
employed.  I  have  several  times  had  to  operate  upon 
cancers  which  had  been  vigorously  and  repeatedly 
treated  with  caustics,  and  to  note  the  comparatively 
admirable  condition,  the  freedom  from  cancer 
premeation  of  the  surrounding  tissues  and  of  the 
axillary  nodes ;  whereas,  after  incomplete  operations 
with  the  knife  the  local  manifestations  of  recur- 
rence were  almost  invariably  deplorable  and  the 
prognosis,  of  course,  invariably  hopeless."    He  also 

17 


says,  "I  doubt  if  any  melanotic  tumor  of  the  skin 
should  be  removed  with  the  knife." 

From  this  review  we  learn  that  since  the  begin- 
ning of  the  nineteenth  century  chemical  caustics 
were  an  increasingly  valuable  resource  of  all  the 
noted  surgeons  in  cancer  therapy  until  Langston 
Parker  (1867)  in  the  Annual  Address  in  Surgery, 
before  the  British  Medical  Association,  showed  that 
they  had  become  a  fair  rival  of  the  knife.  In  spite, 
however,  of  the  undoubted  success  which  attended 
their  use  during  this  period,  we  find  that  they  were 
being  applied  less  frequently  by  the  skillful  surgeons 
during  the  last  quarter  of  the  century.  During  the 
early  years  of  the  tv/entieth  century  their  position 
in  cancer  therapy  is  not  unlike  that  described  by 
Young  over  one  hundred  years  ago.  "Caustic  appli- 
cations," he  says,  "were  ushered  in  under  the 
equivocal  sanction  of  a  nostrum,  they  were  pursued 
as  a  nostrum,  and  then  they  were  turned  out  as  a 
nostrum.  All  regular  inquiry  has  been  withheld 
from  the  merits  of  the  practice,  and  because  it  did 
not  succeed  in  all  things  its  efficacy  was  not  allowed 
to  any.  Thus  transferred  from  the  irregulars  to 
the  regulars  it  was  turned  back  to  its  original 
holders." 

In  the  light  of  this  history  it  may  not  be  un- 
profitable to  ask  if  they  have  a  field  for  use  at  the 
present  time? 

Regarding  the  continuation  of  their  use  by  the 
"original  holders,"  we  may  hope  that  our  educa- 
tional propaganda  and  a  more  intelligent  legislative 
restraint  will  ultimately  solve  that  part  of  the  prob- 
lem. The  question  of  renewal  at  the  present  time 
of  the  consideration  of  their  efficacy  by  the  educated 
surgeon  naturally  reverts  to  an  estimate  of  their 
value  when  previously  used  and  to  the  reason  for 
their  abandonment. 

18 


Their  value  as  compared  with  the  operation  by 
the  knife  was  apparently  not  satisfactorily  defined 
at  the  time  they  were  given  up.  No  statistical  data 
were  available.  We  know  that  operations  with  the 
knife  during  a  greater  part  of  the  nineteenth  cen- 
tury were  almost  invariably  incomplete  and  that  the 
cures  were  few.  Sands  says,  "Now  and  then  a  cure 
was  accomplished."  After  the  use  of  the  chemical 
caustics,  however,  we  have  the  evidence  of  numer- 
ous com-petent  observers  that  the  interval  before  re- 
currences appeared  w^as  often  long,  and  there  is 
much  reason  to  believe  that  cures  were  more  fre- 
quent than  after  operations  with  the  knife.  The 
danger  from  poisoning  was  made  a  negligible  factor 
by  the  very  general  substitution  of  zinc  chloride  for 
arsenic. 

We  do  not  find  therefore  that  their  value  in  the 
hands  of  competent  surgeons  was  discredited,  but 
the  reason  for  their  abandonment  appeared  to  be 
in  the  new  conception  of  the  possibilities  which 
scientific  medicine  furnished  to  the  practical  sur- 
geon during  the  closing  years  of  the  century.  Patho- 
logical anatomy  was  making  an  early  and  exact  diag- 
nosis more  available,  the  results  of  bacteriological 
research  promised  to  make  primary  mortality  a 
negligible  factor  and  primary  healing  of  the  wound 
a  definite  certainty,  thus  encouraging  the  surgeon 
to  believe  that  ultimately  the  development  of  his 
technique  would  preclude  the  necessity  of  using 
chemical  methods  which  were  less  attractive  and  ex- 
tremely difficult  to  apply.  Frequent  and  early  recur- 
rences could  not  obliterate  the  attractiveness  of  the 
primary  result,  and,  until  the  past  decade,  sufficient 
solace  could  always  be  obtained  in  the  idea  that  con- 
stitutional taint  or  heredity  were  compelling  factors 
in  the  unfavorable  progress  of  the  disease. 

19 


The  result  is  that  the  "salvage,"  as  expressed  by 
Clark  in  regard  to  uterine  cancer  is  greater,  but, 
owing  to  our  failure  to  increase  appreciably  the 
number  of  patients  applying  for  treatment  in  the 
earliest  stages  of  the  disease,  the  primary  mortality 
has  markedly  increased,  operative  sequellse  are  fre- 
quent, and  recurrences  are  still  discouragingly  large. 
The  words  of  Peterson  (1912)  are  important,  who, 
after  expressing  his  strong  belief  in  the  radical 
operation  for  carcinoma  of  the  uterus,  says,  "My 
added  experience  has  not  made  me  any  more  confi- 
dent that  the  next  patient  I  operate  upon  will  either 
survive  the  primary  operation  or  will  ultimately  be 
cured."  Finally,  there  is  the  important  fact  that 
the  availability  of  surgical  skill  sufficient  to  effect 
a  respectable  salvage  is  extremely  limited — as  much 
so  as  is  that  of  radium. 

We  believe,  therefore,  that  the  evidence  of  the 
value  of  chemical  caustics  is  sufficiently  strong  to 
justify  a  new  study  of  their  technical  application 
and  a  discussion  of  the  kind  of  cases  in  which  they 
may  be  most  efficiently  applied.  In  so  doing  they 
may  afford  a  valuable  adjuvant  to  the  use  of  the 
knife  and  become  applicable  to  a  number  of  well 
developed  growths,  the  extirpation  of  which  at  the 
present  time  results  in  a  high  primary  mortality 
and  a  high  percentage  of  recurrences. 

Regarding  the  educational  propaganda  of  cancer, 
it  seems  to  the  writer  that  the  study  and  applica- 
tion of  all  reasonable  methods  of  treating  cancer 
will  be  of  aid  in  encouraging  the  public  to  seek  early 
relief  from  competent  hands.  While  anaesthesia 
and  skill  have  diminished  the  dread  of  the  knife,  the 
fear  of  an  operation  still  remains  an  important  rea- 
son for  the  frequent  delays  in  asking  for  advice. 


20 


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Barker,  Fordyce:  Discussion  of  Willard  Parker's 
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Erichsen :    The  Science  and  Art  of  Surgery,  1860. 

Fell:     Cited  by  Langston  Parker. 

Filhos :  De  la  Cauterisation  du  Col  de  I'Uterus  avec  le 
Caustique  Solidifie  de  Potasse  et  de  Chaux,  Paris,  1847. 

Halsted:  The  Results  of  Radical  Operations  for  the 
Cure  of  Carcinoma  of  the  Breast.  Annals  of  Surgery, 
1907,  46,  1.  ^ 

Hunter,  John:     Wolfe. 

Hildanus,  Fabricius:     Wolfe. 

Llandolfi:  Dublin  Quarterly  Jour.,  Nov.,  1855.  Trans- 
lation of  Lasegue's  Review  of  Llandolfi's  Treatment  of 
Cancer. 

Lewis:  The  Use  and  Place  of  Caustics  in  the  Treat- 
ment of  Cancer.    Annals  of  Surgery,  1893,  17,  392. 

Maisoneuve :  Lecons  Cliniques  sur  les  Affections  Can- 
cereuses, Paris,  1852-4. 

21 


Manec :     Cited  by  Langston  Parker. 

Marsden :     Cited  by  Langston  Parker. 

Moore:    Jour.  Brit.  Assoc,  April  21,  1866,  406. 

Pare,  Ambroise:     Arndt  and  Wolfe. 

Parker,  Langston:  The  Modern  Treatment  of  Can- 
cerous Diseases  by  Caustics  or  Enucleation.  London, 
1867.  Annual  Address  in  Surgery  Before  the  Brit.  Med. 
Assoc.      (Contains  literature.) 

Parker,  Willard:  Cancer  of  the  Female  Breast.  Its 
Character,  Diagnosis,  Prognosis,  and  Treatment.  Med- 
ical Record,  1873,  8,  431. 

Parmenter:  On  the  Use  of  Caustics  in  Malignant 
Disease.    Journal  Am.  Med.  Assn.,  1894,  22,  982. 

Pattison:  Cancer:  Its  Nature  and  Successful  and 
Comparatively  Painless  Treatment,  1866. 

Peterson:  Primary  and  End  Results  of  51  Radical 
Abdominal  Operations  for  Cancer  of  the  Uterus.  Trans. 
Amer.  Gyn.  Soc,  1912,  37,  295. 

Peyrilhe:     Cited  by  Wolfe. 

Recamier:  Recherches  sur  le  Traitement  du  Cancer 
par  les  Compression,  etc.     Paris,  1829. 

Rivallie:  Traitement  du  Cancer  par  TAcide  Nitrique 
Solidifie.     Paris,  1850. 

Robinson:  Some  Considerations  on  the  Treatment  of 
Cutaneous  Malignant  Epitheliomata.  International 
Jour.  Surgery,  1892,  5,  179. 

Routh:  A  New  Mode  of  Treating  Cancer  of  the 
Cervix  Uteri.    Obstet.  Soc.  of  London,  Oct.  3,  1866. 

Sands:     Discussion  of  Willard  Parker's  Paper. 

Smith,  Stephen :  The  Treatment  of  Cancerous  Ulcers 
and  Growths  Not  Removable  by  the  Knife.  Medical 
Record,  1880,  17,  165. 

Snow:  The  Path  of  Improvement  in  Cancer  Treat- 
ment.   Med.  Press  and  Circular,  1893,  1,  659. 

Storck :    Cited  by  Arndt. 

Thomas,  T.  G.:     Diseases  of  Women,  1869. 

Tilt:     The  Change  of  Life  in  Health  and  Disease. 

Velpeau:  Traitement  des  Maladies  du  Sein,  et  de  la 
Region  Mammaire,  etc.,  1854,  63,  676. 

Warren,  J.  Collins:  Personal  Experience  in  the 
Treatment  of  Cancer.  Boston  Med.  and  Surgical  Jour., 
1887,  116,  154. 

Wolff:  Die  Lehre  von  der  Krebskrankheit,  1907. 
(Contains  the  older  literature  and  a  historical  review 
of  the  use  of  caustics  among  the  ancients  and  during 
the  middle  ages.) 

22 


Woelfler:  Zur  Geschichte  und  Operativen  Behand- 
lung  des  Zungenkrebses.  Archiv.  f.  kl.  Chir,,  26,  314. 
(Contains  literature.) 

Young:  An  Inquiry  into  the  Nature  and  Action  of 
Cancer.     London,  1805. 


23 


A  COMPOSITE  FAG-SIMILE 


MEDICAL   RECORD 

A  Weekly  Journal  of  Medicine  and  Surgery 

WILLIAM  WOOD  AND  COMPANY    Pubir*h*n,  61  Fifth  Av«nu«.  Naw  Yofli 


SS.OO  Per  Annum. 


Published  at  New  York  Every  Saturday 


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ORIGINAL    ARTICLES 

The  Occupntlon&l  Neuroses.  A  Otin- 
teal  Study  of  One  Hundred  C«ees. 
By  Charles  U  Dana,  M.£>..  Nuw 
York      .*.....-. 

Failure  of  the  Colon  to  Rotate-  By 
Charles  H.  A^ajo.  M.D..  RoohesCer. 
Minn .,.  .'i 

One  Year's  Experience  wUh  Salvar- 
san.  Being  a  Heport  of  230  Injec* 
lions  with  Special  Reference  to  Eye 
and  £ar  Complications.  By  B.  C 
Corbus.   M.D..    Chicago.   IlL    

The  Quantitative  Analysts  of  Human 
aad  of  Cows"  Milk.  By  Arthur  V 
Meigs.  M  D..  and  Howard  U 
Marsh.    B  S..    Philadelphia  

Notes  on  the  Neurology  of  Voluntary 
Movem en t.  By  George  Va n  Ness 
Dearborn.  M  D..  Boston.  Mass 

Notts  Upon  a  So-Called  Parasite  of 
Yellow  Fever  (Seldelln)  By  Arls- 
tldes  Asramonte,  A.B..  M.D.,  Ha* 
vana,    Cuba    

Ghorloeplthelionia  Malignum  Report 
of  a  Case  Following  Abortion;  Ova- 
ries Retained.  Complete  Recovery; 
"With  Detailed  Report  of  the  PatH- 
ologlst.  By  Wm.  H.  Dukeman. 
M.D..    Lob    Angeles.    Cal.-..^,'y' 

Hysteria  and  Psychotherapy  By 
£ue:en«  D  Bondurant.  M.O.,  Mo 
bile.  Ala. 

A  Suggested  Readjustment  of  Our 
Views  on  Heart  Examinations  for 
Life  Insurance.  By  Chas.  F  Mar? 
tin.    M.D..    Montreal.    Can 

8ome  Points  In  the  Diagnosis  and 
Treatment  of  Intranasal  SuppunL- 
tion.  By  James  Donelan.  M.CIu 
M.  B..    London    - 

EOIT0RIAL&. 

More    Bleep    c .■^. 

The  Prortssional  Secret  and  the  Re- 
porting  of    Venereal   Diseases...   .. 

Flnger-Prlnt    Evidence >.. *- 

Fresh  Air  in  Schools  and  'Hospitals 

EDITORIAL   NOTES. 

Nephrotyphus— Athletes  an4  Long 
Life     

The   Discretion  of   the   Surgeon 

Selenium  In  tlje  Treatment  of  Cancer 

The  Seriousness  of  Measles 

The  Triumph  of  American  Medicine  In 
the  Construction  of  the  Panama 
Canal       


NEWS    OF    THE    WEEK. 

Practical  Eugenics— Measles  Prevalent 
—For  Pure  Water— Smallpox  Ei>l-' 
demic — Surgery  Under  Ulffleultles 
— Newspapers  Help  Tuberculosis 
Flghi — Wood  AUoho)  Poisoners — 
Radium  Standard — Heredity  and 
Hare  Llp — Candidates  for,  Noble 
Prize — Resignation  of  a  I^o^pital 
Start— Charitable  Gifts — New  Hoa- 
piial   for   Colored    Persona     ,,. 

Nurses  Revise  Their  Charges — Women 
Physicians  Try  for  Ambulance  Serv- 
ice— "Healer"  Found  Gulfiy — En- 
dowment Fund  for  Homeopathy— 
Ameiican  Medical  Editors'  Asso- 
ciation— Venereal  Diseases  to  Be 
Reported  In  New  York— Menlngttla 
In  Oklahoma— Health  of  the  Canal 
Zone — Tuberculosis  Amone  Alaska 
Indiana— Lepers  In  New  York...— 

OBITUARY 

John    Herr   Uusser.    M  D..tvv«.->^,M 

Leonard    Weber.    MD 

Charles    Bell   Converse.    M.D 

Thomas  pwlght-   M  D.     LL.D 

eORRESPONDENCe. 
Christian    Seience    In     the    Panama 

Our  London   Letter    

Our  Letter   from    Parta 

Our  Berlin    Letter      

Our  Letter  from  the  PhlUpplnw 

Our  Canadian   Letter .--....^ 

PROGRESS  OF  MEDICAL  SGIENCE. 

End  Results  of  Surgery  in  Neuras- 
thenics and  on  Neurasthenia 

Primary  Tumors  of  the  Spleen  — 
Urinary  Infection  —  The  Prevention 
of  Eclampsia  —  Chylous  Ascites  — 
Relation  of  Intestinal  Toxemia  to 
Chronic  Arthritis — Creative  Surgery 

Combined  Infestation  with  -  Ascarla 
and  Hookworm — Extradural  Hemor- 
rhage— Anesthesia  In  Tonsil  Enu- 
cIeatloTi-^Antlt>*photd  Vaccinal  ton— 
Convalescent  Carriers  of  Typhoid- 
Streptococcus  Vaccines  In  Scarlet 
Fever    Prophy!a.j:i3    ,-, - 

INSURANCE  MEDICINE. 

Suggestions  to  M ed leal  E3Canilner& 
By  the  Insurance  Sdltor  Th« 
Physical    Examination    

Wassermann  Reaction  Irt  Judging  a 
Claim  for  Indemnity — A  Case  of 
Multiple  Sclerosis  from  Chronic  Gas 
Poisoning     ■ 

The  Mortality  of  Alcohol— Medical 
Section  of  the  American  Life  Con- 
vcntion^Pleurlsy   and    Insurance 


BOpK    ffEVlEWS. 

A  Practical  Medical  Dictionary  of 
Words  Oaed  In  Medicine.  With 
Their  Derivation  and  Prondncfatlon. 
Including  Dental.  Veterinary. 
Chemical,  Botanical.  EHectrlcal,  Life 
Insurance  and  Other  Sp«eial  Terms. 
By  Thomas  I^lhrop  Stedman,  M.D 
Illustrated 

American  Practice  of  Surgery  A 
Complete  System  of  the  Science  nr\d 
Art  of  Surgery  by  Represcnta(iv« 
Surgeons  of  the  United  States  and 
Canada.  Editors:  Joseph  D.  Ervant, 
M.D  .  Albert  H.  Buck,  M.D.  Com- 
plete In  Eiglit  Voluraes.  Profuse^ 
UluMrated.      Volume   V/II 

Surgery  of  Deformitlps  of  the  Fao^- 
Includlng  Cleft  Palate.  By  John  B. 
Roberts.  A.  M.  M.  D.  Illustrated 
with    J7J    engravings .■. .. 

SOCIETY   REPORTS. 
Mississippi  Valley  Medical  Association 
American  Association  of  Medical  Ex- 

Americ^an  Medical  Associai.on 

Southern  Surgical  and  Gynecological 
Association 

New  York  Aeademy  of  Medicine...'.,. 

The  Western   Surgical   Association:.. 

ConneeCleut  State  Medical  Society.,. 
''MEOtCOLEGAL  NOTES. 

Malpractice — Responsibility  for  Op- 
eration Conducted  by  Another 

Finger  Print  Impressions  as  Evidence 
— Testatncnlary  Capacity — Effect  ol 
Disease — Dentist  Not  a  Surgeon 
Within  Statute  on  Privileged  Com- 
munications —  Scope  of  FrlvUecpd 
Communications  —  Munlcipallfy's 
Power  to  Contract  for  Medlciil  Ser- 
vices— Expert    Evidence    In    Muiider 

STATE  MEDICAL  LICENSING  BOARDS 
State  Board  Bxamlnatlon  Questlona— 

Ohio  State  Medical   Board 

Answers  to  State  Board  Examination 

Questions  —  Ohio     State     Medical 

Advanced  Requirements  of  PrelVm- 
hiary    Eduealion   .■... 

Bulletin  of  Approaching  Examination* 
NEW    INSTRUMENTS. 

A  Needle  Holder  for  the  Intravenous 
Administration  of  Falvargan.  By 
Hdbert  V    Guile.  M.D.   New  York. 

MEDICAL    ITEMS. 
Contagious    Diseases — Weekly    St4ta- 

roent^Heaith    Reports 

DIRECTORY       OF       NATIONAL       AND 
k    STATE.  MEDICAL    SOCtETIES. 


jvSt  pubhshep 


URGENT  SURGERY 


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Volume  Two— The  set.  with  20  PuH-pase  Platet  and  9<>4  Illustrations 


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